Volume 44, Number 5
September 2014
Letter From the Guest Editor: Update in Cardiovascular Nuclear Medicine (Part II)
T
his is Part 2 of an update in Cardiovascular Nuclear Medicine, focusing here on cardiac PET. The issue opens with a comprehensive review by Drs Maddahi and Packard on the state of PET perfusion tracers.1 While clinical PET perfusion is currently limited to 82Rb and 13NH3, newer agents under investigation, such as 18F flurpiridaz, promise to make PET more widely accessible and to produce images that are even better than those with current tracers. The clinical utility of perfusion PET has been extensively investigated by the team at the Brigham and Women's Hospital, with the superb review by Drs Dorbala and DiCarli demonstrating the diagnostic and prognostic advantages of PET, which can be further enhanced by the ability to derive true quantitative coronary blood flow measurements.2 Over many years, PET has also shown unique strength in the assessment of myocardial viability in patients with severely depressed cardiac function. The excellent review by Drs Lim, McArdle, Beanlands, and Hessian demonstrates that, in spite of some contrary opinions based on the results of STICH (Surgical Treatment of Ischemic Heart Failure), PET viability assessment is very beneficial in suitable patients.3 Drs Jain and He's excellent review of hot spot imaging using 18 FDG, including their unique work imaging the effect of ischemia on the myocardium, reminds us that radionuclide detection of coronary disease should be more than assessment of blood flow heterogeneity by also pursuing direct imaging of the myocardial cellular effects of the condition.4 In addition, their description of imaging of active myocardial sarcoidosis is important as frequent cardiac involvement with this disease is becoming increasingly recognized. The following comprehensive discussion by Drs Wollenweber and Bengel further highlights that radionuclide imaging is unique in its ability to
332
http://dx.doi.org/10.1053/j.semnuclmed.2014.07.002 0001-2998/& 2014 Elsevier Inc. All rights reserved.
visualize and understand the molecular processes that underlie cardiac disease.5 Such knowledge serves not only to assess ongoing disease processes, but it may also help monitor and guide therapy, as well as identify disease in an early stage. Finally, from the review by Drs Heo, Nakazato, and Min, we are reminded that there are important advantages of combining radionuclide imaging with other noninvasive techniques such as cardiac CT and MRI, with each modality contributing unique understanding of cardiac disease.6 The editors hope that this comprehensive 2-part series on the latest in cardiovascular nuclear medicine will serve as a helpful review and reference as we continue to make advances in combating the large burden of cardiovascular disease. Mark I. Travin, MD Division of Nuclear Medicine, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY E-mail address: mtravin@montefiore.org
References 1. Maddahi J, Packard RRS: Cardiac PET perfusion tracers: Current status and future directions. Semin Nucl Med 2014;44(5):333-343 2. Dorbala S, Di Carli MF: Cardiac PET perfusion: Prognosis, risk stratification, and clinical management. Semin Nucl Med 2014;44(5):344-357 3. LIM SP, Mc Ardle BA, Beanlands RS, Hessian RC: Myocardial viability: It is still alive. Semin Nucl Med 2014;44(5):358-373 4. Jain D, He Z-X, Lele V: Cardiac hot spot imaging with 18FDG. Semin Nucl Med 2014;44(5):374-384 5. Wollenweber T, Bengel FM: Cardiac molecular imaging. Semin Nucl Med 2014;44(5):385-396 6. Heo R, Nakazato R, Kalra D, Min JK: Noninvasive imaging in coronary artery disease. Semin Nucl Med 2014;44(5):397-408
September 2014
Letter From the Guest Editor: Update in Cardiovascular Nuclear Medicine (Part II)
T
his is Part 2 of an update in Cardiovascular Nuclear Medicine, focusing here on cardiac PET. The issue opens with a comprehensive review by Drs Maddahi and Packard on the state of PET perfusion tracers.1 While clinical PET perfusion is currently limited to 82Rb and 13NH3, newer agents under investigation, such as 18F flurpiridaz, promise to make PET more widely accessible and to produce images that are even better than those with current tracers. The clinical utility of perfusion PET has been extensively investigated by the team at the Brigham and Women's Hospital, with the superb review by Drs Dorbala and DiCarli demonstrating the diagnostic and prognostic advantages of PET, which can be further enhanced by the ability to derive true quantitative coronary blood flow measurements.2 Over many years, PET has also shown unique strength in the assessment of myocardial viability in patients with severely depressed cardiac function. The excellent review by Drs Lim, McArdle, Beanlands, and Hessian demonstrates that, in spite of some contrary opinions based on the results of STICH (Surgical Treatment of Ischemic Heart Failure), PET viability assessment is very beneficial in suitable patients.3 Drs Jain and He's excellent review of hot spot imaging using 18 FDG, including their unique work imaging the effect of ischemia on the myocardium, reminds us that radionuclide detection of coronary disease should be more than assessment of blood flow heterogeneity by also pursuing direct imaging of the myocardial cellular effects of the condition.4 In addition, their description of imaging of active myocardial sarcoidosis is important as frequent cardiac involvement with this disease is becoming increasingly recognized. The following comprehensive discussion by Drs Wollenweber and Bengel further highlights that radionuclide imaging is unique in its ability to
332
http://dx.doi.org/10.1053/j.semnuclmed.2014.07.002 0001-2998/& 2014 Elsevier Inc. All rights reserved.
visualize and understand the molecular processes that underlie cardiac disease.5 Such knowledge serves not only to assess ongoing disease processes, but it may also help monitor and guide therapy, as well as identify disease in an early stage. Finally, from the review by Drs Heo, Nakazato, and Min, we are reminded that there are important advantages of combining radionuclide imaging with other noninvasive techniques such as cardiac CT and MRI, with each modality contributing unique understanding of cardiac disease.6 The editors hope that this comprehensive 2-part series on the latest in cardiovascular nuclear medicine will serve as a helpful review and reference as we continue to make advances in combating the large burden of cardiovascular disease. Mark I. Travin, MD Division of Nuclear Medicine, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY E-mail address: mtravin@montefiore.org
References 1. Maddahi J, Packard RRS: Cardiac PET perfusion tracers: Current status and future directions. Semin Nucl Med 2014;44(5):333-343 2. Dorbala S, Di Carli MF: Cardiac PET perfusion: Prognosis, risk stratification, and clinical management. Semin Nucl Med 2014;44(5):344-357 3. LIM SP, Mc Ardle BA, Beanlands RS, Hessian RC: Myocardial viability: It is still alive. Semin Nucl Med 2014;44(5):358-373 4. Jain D, He Z-X, Lele V: Cardiac hot spot imaging with 18FDG. Semin Nucl Med 2014;44(5):374-384 5. Wollenweber T, Bengel FM: Cardiac molecular imaging. Semin Nucl Med 2014;44(5):385-396 6. Heo R, Nakazato R, Kalra D, Min JK: Noninvasive imaging in coronary artery disease. Semin Nucl Med 2014;44(5):397-408
